What imaging procedures require prior plan approval?
Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for BCBSNC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans): • CT/CTA scans • MRI/MRA scans • PET scans • Nuclear cardiology studies Prior plan approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient or observation stay), urgent care center or ambulatory surgical center. Prior plan approval also is not required for “low-tech” procedures such as X-rays and mammograms.
